Association Between Inflammatory Biomarkers and Nonspecific Low Back Pain

Abstract

Objectives: Chronic inflammation increases the production of cytokines and activates proinflammatory pathways which may lead to nonspecific low back pain (LBP). We systematically reviewed the literature to investigate whether inflammatory biomarkers are associated with nonspecific LBP. Materials and Methods: CINAHL, Medline, and Embase were searched between January 1946 and May 2018. MeSH terms and key words were used to identify studies examining the association between inflammatory biomarkers and LBP. Two reviewers performed the risk of bias assessment and 3 reviewers extracted data independently. Qualitative evidence synthesis was performed. Results: Thirteen studies, ranging from fair to low quality, were included. Five studies examined the association between C-reactive protein (CRP)/high-sensitivity CRP and LBP; 6 studies assessed tumor necrosis factors (TNFs); 8 studies assessed interleukins (ILs); and 2 studies assessed fibrinogen. There was evidence for an association of elevated levels of CRP, TNFs, and IL-6 with LBP. There was conflicting evidence for an association between IL-1β, fibrinogen, and LBP. Discussion: Our findings support the notion of a positive association between inflammatory biomarkers and nonspecific LBP, specifically for CRP, TNFs, and IL-6. Although further high quality longitudinal studies are needed to confirm these findings and evaluate the magnitude of these associations, our findings suggest a role of inflammation in the pathogenesis of nonspecific LBP.

Association between type 2 diabetes and chronic low back pain in general practices in Germany

“…28 35 Low-grade systemic inflammation may favor the occurrence of type 2 diabetes via molecular pathways enhancing insulin resistance (eg, activation of Jun kinase and downregulation of peroxisome proliferator-activated receptor (PPAR)-γ expression), 27 while proinflammatory molecules may contribute to back pain through the sensitization of peripheral nociceptors and the promotion of hyperalgesia. 28 Another interesting finding of this study is the sexrelated difference in the association between type 2 diabetes and CLBP. Indeed, the relationship between type 2 diabetes and CLBP was positive in women and negative in men.…”

Bidirectional longitudinal associations between loneliness and pain, and the role of inflammation

“…Inflammation contributes to the experience of many types of disease-related pain, and there are associations between inflammatory biomarkers and nonspecific pain. 23 Low grade systemic inflammation may induce sensitization of pain pathways and peripheral nociceptors. 2; 16 There is also evidence that inflammation is related to loneliness, possibly as part of the stress response associated with perceptions of social isolation, Thus loneliness is associated with proinflammatory gene expression, 8 and with elevated levels of markers of inflammation such as C-reactive protein (CRP) and interleukin-6.…”

Efficacy, cost-utility and physiological effects of Acceptance and Commitment Therapy (ACT) and Behavioural Activation Treatment for Depression (BATD) in patients with chronic low back pain and depression: study protocol of a randomised, controlled trial including mobile-technology-based ecological momentary assessment (IMPACT study)

“…8 In particular, cytokines appear to have a crucial role in chronic pain conditions, so that a high expression of proinflammatory mediators can alter the physiopathology of chronic pain. 9 At the same time, inflammatory mediators of innate immunity and cell-mediated immunity cooperate in the onset and expression of depression. 10 On the other hand, a clear correlation between vitamin D deficiency and the presence of chronic pain and depression has been described in recent years.…”